Introduction
As science and clinical research advances, we are discovering that a number of diseases share similar underlying biological causes or processes. This has led to the development of medicines that are effective across several different diseases.
For example, a medicine developed to tackle one condition like asthma, may also be found to be useful for treating eczema. These are called ‘multi-indication medicines’ (or therapies).1
They may be approved for use across a range of conditions, from cancer to respiratory diseases and neurological conditions.2
Why are multi-indication pricing solutions needed?
Under the current pricing framework in England, NICE3 will assess how much value the medicine offers to patients, their families, and to the NHS. Patients can then get access to a medicine once the pharmaceutical company and NHS agree a ‘cost-effective’ price.
NHS England operates under a uniform pricing model. This means that other than in “exceptional circumstances”, a medicine must have one “cost-effective” price.
As a result, a multi-indication medicine must have one single price across all the disease indications it is used to treat. However, it is unlikely that a medicine will provide the same value for money across all conditions.
This lack of flexibility in the system can lead to a mismatch between the price and value of a medicine, often meaning the medicine is not considered cost-effective and is not made available to patients on the NHS.4
This may have a significant impact on patient choice and outcomes. A Sanofi-funded analysis of terminated NICE appraisals for multi-indication treatments between July 2016 and December 2023 estimates that approximately 829,000 patients in the UK have been prevented from accessing medicines.5
Multi-Indication Pricing (MIP) agreements allow for the price of a single treatment used for different conditions to vary based on its ‘value’ in each indication. It aims to align the price of a medicine with its value in treating each condition, ensuring that patients receive the most effective medicines at a fair price for the NHS.6
By creating a system that allows medicine pricing to reflect clinical value, we believe multi-indication pricing can help improve patient access to innovative treatments and position the UK as an attractive destination for life sciences research and development.
The opportunity for change
Sanofi is calling on the Government and NHS England to work with patient groups and pharmaceutical companies to provide a route to multi-indication pricing. The update of the NHS Commercial Framework for New Medicines in late 20247 is a key opportunity to consider how to recognise value at the indication level - and ultimately to ensure patients are not denied access to treatment.
There are a wide range of pragmatic solutions to support the implementation of indication-based pricing agreements efficiently.
The UK has the opportunity to be world-leading in the development, testing, and uptake of new, innovative treatments. However, this will only be possible by adopting flexible pricing solutions that enable access to innovation.8
Let’s work together to re-write the rulebook, so no patient loses out.
References
- Cole, A., Neri, M. and Cookson, G., 2021. Expert Consensus Programme: Payment Models for MultiIndication Therapies. OHE Consulting Report, London: Office of Health Economics. Available at: https://www.ohe.org/publications/payment-models-multi-indication-therapies
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KPMG. The Pricing and Market Access Landscape for Multi-Indication Products:Challenges and Opportunities in Europe https://assets.kpmg.com/content/dam/kpmg/uk/pdf/2023/10 /the-pricing-and-market-access-landscape-for-multi-indication-products.pdf
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NICE. https://www.nice.org.uk/
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Cole, A., Towse, A., Lorgelly, P. and Sullivan, R. (2018). Economics of Innovative Payment Models Compared with Single Pricing of Pharmaceuticals. OHE Research Paper 18/04, London: Office of Health Economics. Available at: https://www.ohe.org/publications/economics-innovative-payment-models-comparedsingle-pricing-pharmaceuticals#overlay-context=publications
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Is the United Kingdom (UK) medicines pricing policy failing patients? The impact of terminated National Institute for Health and Care Excellence (NICE) appraisals for multi-indication products on patients. Helen Mitchell et al. https://www.medrxiv.org/content/10.1101/2024.08.06.24311489v1.full-text
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Neri, M., Towse, A. and Garau, M. (2018). Value Assessment of Multi-Indication Pricing (MIP): Practical Solutions and Steps to Move Forward. OHE Briefing, London: Office of Health Economics.
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NHS Commercial Framework for New Medicines https://www.england.nhs.uk/long-read/nhs-commercial-framework-for-new-medicines-consultation-phase-1/
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Towse, A., Cole, A., and Zamora, B. (2018). The Debate on Indication-Based Pricing in the U.S. and Five Major European Countries. OHE Consulting Report, London: Office of Health Economics. Available at: https://www.ohe.org/publications/debateindicationbased-pricing-us-and-five-major-european-countries
MAT-XU-2403757 (v1.0)
Date of preparation: October 2024